Telehealth_Speciality_Service_Performance_Work_Statement.docx

Billings Area Indian Health Service Billings Area Telehealth Specialty Clinics Performance Work Statement

Table of Contents

Background

The Billings Area Office (BAO) of the Indian Health Service (IHS) is charged with providing healthcare services to the eligible Native American population within Montana and Wyoming. In order to achieve IHS' commitment for improving Billings Area's health care system to allow better access and efficient spending to patients, the IHS intends to expand the utilization of health care services provided through telehealth specialty services.

Statistics and Workload

Ambulatory Patient Count/Workload

The National Data Warehouse (NDW) published the fiscal year 2017 and 2018 ambulatory patient count and/or workload as follows:

Workload

Purchased Referred Care Total Referrals

Direct Inpatient Workload

The National Data Warehouse published the fiscal year 2017 and 2018 as follows:

Blackfeet Indian Hospital

Crow/Northern Cheyenne Indian Hospital

Top Ten Purchase Referred Care Categories

Blackfeet Service Unit

· MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE

· RESPIRATORY SYSTEM

· EAR, NOSE, MOUTH & THROAT

· EYE

· FEMALE REPRODUCTIVE SYSTEM

· CIRCULATORY SYSTEM

· FACTORS INFLUENCING HEALTH STATUS & OTHER CONTACTS WITH HEALTH SERVICE

· NERVOUS SYSTEM

· DIGESTIVE SYSTEM

· MYELOPROLIFERATIVE DISEASES & DISORDERS, POORLY DIFFERENTIATED NEOPLAS

Crow Service Unit

· RESPIRATORY SYSTEM

· RESPIRATORY DISORDERS

· ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES & DISORDERS

· NERVOUS SYSTEM

· CEREBROVASCULAR DISRDERS

· EYE

· EAR, NOSE, MOUTH & THROAT

· HEMATOLOGICAL DISORDERS

· INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS

· MULTIPLE SIGNIFICANT TRAUMA

Wind River Service Unit

· INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS

· OTHER SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS

· MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE

· KIDNEY & URINARY TRACT

· CIRCULATORY SYSTEM

· DIGESTIVE SYSTEM

· HEPATOBILIARY SYSTEM & PANCREAS

· MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS

· NEOPLASMS

· ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES & DISORDERS

Northern Cheyenne Service Unit

· INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS

· NEWBORNS & OTHER NEONATES WITH CONDITIONS ORIGINATING IN PERINA

· CARDIOVASCULAR DISORDERS

· EAR, NOSE, MOUTH & THROAT

· PREGNANCY, CHILDBIRTH & THE PUERPERIUM

· MENTAL DISEASES & DISORDERS

· FACTORS INFLUENCING HEALTH STATUS & OTHER CONTACTS WITH HEALTH SERVICE

· BLOOD, BLOOD FORMING ORGANS, IMMUNOLOGIC DISORDERS

· BURNS

· RESPIRATORY SYSTEM

Fort Peck Service Unit

· INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS

· NEWBORNS & OTHER NEONATES WITH CONDITIONS ORIGINATING IN PERINA

· CARDIOVASCULAR DISORDERS

· EAR, NOSE, MOUTH & THROAT

· PREGNANCY, CHILDBIRTH & THE PUERPERIUM

· MENTAL DISEASES & DISORDERS

· FACTORS INFLUENCING HEALTH STATUS & OTHER CONTACTS WITH HEALTH SERVICE

· BLOOD, BLOOD FORMING ORGANS, IMMUNOLOGIC DISORDERS

· BURNS

· RESPIRATORY SYSTEM

No-Show Percentages

Blackfeet Indian Hospital

Heart Butte Clinic 49.7%

62.5%

Crow Indian Hospital

Lodge Grass Clinic

Pryor Clinic 51.1%

54.7%

54.8%

Fort Peck Health Center

Wolf Point Clinic 45.7%

51%

Contractor will hold harmless the facility and/or program with any and all no-shows by not charging a fee.

Service Unit Specialty Clinic Priority

Service Unit

General Requirements Under this contract, the Contractor is responsible for the planning, coordination, development, implementation, delivery, management of program and quality assurance of telehealth solutions that will allow IHS patient’s access to Telehealth Specialty Clinics for defined clinical domains and Scope of Service within their Service Unit, significantly improving access to care by reducing the delay and costs involving patient travel. Specifically, the purpose of this requirement is to acquire a solution for the provision of telehealth for specialty referral services including option for provider-to-provider consultations. Contractor services will augment services and be considered an extension and partner of Indian Health Service. Specialty Clinics will also include behavioral health support and assessments. The work involves providing expert medical care including prevention, health maintenance, early diagnosis, complex diagnosis, treatment and follow up services to patients.

Indian Health Service will submit claims for reimbursement through Medicare, Medicaid, and Private Health Insurance for all telehealth specialty services and hospitalist services provided by contractor.

Non-Personal Services The Government shall neither supervise contractor employees nor control the method by which the contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual contractor employees. It shall be the responsibility of the contractor to manage its employees and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the contractor believes that any actions constitute, or are perceived to constitute personal services, it shall be the contractor's responsibility to notify the Contracting Officer (CO) immediately.

Business Relations The contractor shall successfully integrate and coordinate all activities needed to execute the telehealth specialty clinics requirement. The contractor is required to provide quality assurance services and effective management of subcontractors. The contractor shall seek to ensure customer satisfaction and professional and ethical behavior of all contractor personnel.

The contractor shall accomplish the assigned work by employing and utilizing qualified personnel with appropriate combinations of education, training, licensure/certification and experience. The contractor will maintain accreditation for telehealth specialty services by a nationally recognized accreditation organization. The contractor shall ensure the labor categories and labor rates utilized for the performance under the awarded contract will be maintained throughout the performance period.

Location and Hours of Work Accomplishment of the results contained in this PWS requires work at various Government (IHS) facilities. Normal workdays are Monday through Friday except US Federal Holidays. Workers typically work eight (8) hours per day, 40 hours per week. Flextime workers start not earlier than 0600 and not later than 2100 (Mountain time zone). Care hours of work are from 0900 to 1700 daily. All employees and required services are expected to be available during core hours.

Blackfeet Service Unit – Hospital

Heart Butte Clinic Hospital Circle Browning, MT 59417

Heart Butte, MT 59448 Garland Stiffarm

Fort Peck Service Unit

Wolf Point Clinic 107 H Street East Poplar, MT 59255

550 6th Avenue North Wolf Point, MT 59201 Julie Bemer

Crow Service Unit

Lodge Grass Clinic

Pryor Clinic I-90, Exit 510 Crow Agency, MT 59022

Lodge Grass, MT 59050

Pryor, MT 59066 Darren Crowe

Northern Cheyenne Service Unit

Cheyenne Avenue Lame Deer, MT 59043 Debby Bends

Fort Washakie, WY 82514 Steven Landsberry

Travel/Temporary Duty (TDY):

All travel requirements (including plans, agenda, itinerary, or dates) shall be pre-approved by the government (subject to IHS and local policy procedures), and is on a strictly cost reimbursable basis. Costs for travel shall be billed in accordance with the regulatory implementation of Public Law 99-234 and FAR 31.205-46 Travel Costs (subject to IHS and local policy & procedures; may reference FAR).

The Contractor will be responsible for coordinating the logistics of all training to include travel, per diem, lodging of non-federal subject matter expert instructors. Travel for training participants will not be covered under this contract.

Performance Requirements

Telehealth Specialty Clinics

The contractor shall provide licensed practitioners who are permitted by law to provide patient care services independently. All providers must continuously meet the qualifications, standards, requirements of Indian Health Service and Medical Staff Bylaws for each facility they are providing services in order to carry out, at a minimum, the following telehealth specialty clinics:

· Cardiology

· Pediatric Cardiology

· Dermatology

· Endocrinology

· Ear, Nose, and Throat

· Gastroenterology

· Pediatric Gastroenterology

· Hepatology

· Infectious Disease

· Internal Medicine

· Nephrology

· Orthopedics

· Neurology

· Pain Management (Physiatrist PM&R)

· Psychiatry Adult and Pediatric

· Behavioral Health Nurse Practitioner

· Counselor

· Rheumatology

· Wound Care (Infectious Disease, Podiatry) Existing regulations require that these individuals be graduates of approved recognized programs in their fields and legally qualified to practice in a federal facility. Applicants for membership on the Medical Staff must meet the qualification standards developed by the Commissioned Corps of the Public Health Service or the Office of Personnel Management. Providers working with contractor and must be approved by the Governing Body by being privileged prior to performing any services within Billings Area Indian Health Service.

The Contractor will provide licensed nursing support for mentoring of existing nursing staff at each location, provide nursing education, conduct appointment reminder calls, perform follow up of discharged patients, facilitate and coordinate discharge planning efforts for patients in community facilities and assist in scheduling of patients.

Contractor will receive referrals and/or consults through the Electronic Health Record from the Improving Patient Care (IPC)/Primary Care providers/teams assigned to each service unit. Contractor will be responsible for managing the consults received, determine the appropriate coordination of care and documented on the consult, and identify the necessary scheduling instructions.

Contractor will provide the necessary supervisory resources to manage the telehealth specialty services clinics.

Contractor will provide 24 hours/seven days per week on-call Behavioral Health Services outside of business hours for each facility. On-call services will be required to call back within 15 minutes of initiated request for behavioral health services.

Contractor will perform scheduling activities that allows patients to be seen within 30 days from date of request or date identified by provider for return to clinic. Contractor will maintain appropriate clinic wait lists for those patients that cannot be seen within the 30 days from date of request or date identified by provider for return to clinic. Contractor will move all patients identified on the wait list to schedule as appointment slots are available. Contractor will provide additional provider resources if necessary to ensure patients are seen within 30 days. To maintain continuity, contractor will provide clinicians that provide services to patient on a consistent basis (i.e., patient seeing the same provider). Contractor will conduct 60 minutes sessions with new patients to that particular provider and 30 minutes of subsequent follow up appointments, as appropriate.

Hospitalist Services Contractor will provide Hospitalists telehealth services to general medical (age 18 and over) and surgical inpatients via two-way mobile video access. The Hospitalist services should support local provider and nursing staff in a variety of ways, including access to expert hospitalist support, real time physician access for overnight/urgent needs, and compliance with evidence-based practices, quality and documentation standards. The Hospitalist telehealth services should be available 24/7/365 to Crow Service Unit and Blackfeet Service Unit only.

The Hospitalist should be available for consult and patient transfer assistance for Wind River Service Unit, Northern Cheyenne Service Unit and Fort Peck Service Unit. The Hospitalist telehealth services should include the following support services:

· Preliminary admission orders and brief progress note with pertinent information.

· Follow up on tests and imaging ordered on admission.

· Possible physician examination findings; heart, lung, and general appearance.

· Consult with admitting practicing provider on initial assessment and plan.

· Provide medical decision making regarding EKGs, change in condition, lab and imaging results, address medication concerns and care orders.

· Initiate orders to address concerns as they arise.

· Telemetry interpretation (not monitoring).

· Support nursing staff with questions from patient and/or family members.

· Assess patient for change in status, rapid response and codes.

· Provide recommendations and chart reviews.

· Consult and order as determined by the Hospitalist.

· Review problem list to optimize complexity and documentation for appropriate level of care.

· Provider internal medicine consultations for Nurse Practitioner and/or Physicians Assistants.

· Support nursing staff with insulin drips, ordered treatments or medications, etc. as needed.

· Assess necessity for transfer.

· Support access to emergency flight transport teams.

· Streamline access to specialists for inpatient care.

· Assistance with Utilization Review

Pharmacy Services Contractor will provide professional pharmacy services for Inpatient Ward and/or Emergency Room/Urgent Care (ER/UC) Departments during hours when local pharmacy services are closed. Contractors providing these services will be under the review and supervision of the Chief Pharmacist, or their designee, at each participating service unit in the Billings Area.

For Hospitals, the expected times to provide these professional pharmacy services are 1900-0800, 7 days per week AND 0800-1900 on all Federal holidays.

For Outpatient Clinics with Urgent Care services, the expected times to provide these professional pharmacy services are 1900 to 0800 (Monday evening through Friday morning), 1900 Friday through 0800 the following Monday AND 0800-1900 on all Federal Holidays.

Professional pharmacy services to be provided will include:

· processing and verification of medication orders in the RPMS/EHR system

· receiving and responding to requests for medication information and recommendations

· provide medication counseling to patients discharged from the ER/UC

Inpatient orders shall be processed within 15 minutes of order entry, or upon urgent request from the Service Unit.

ER/UC orders will be processed within 30 minutes, or upon urgent request from the Service Unit.

Quarterly quality reviews will include, but are not limited to:

· number of direct provider and patient contacts

· number of orders processed and verified

· timeliness of response to requests

· appropriate documentation of interventions and recommendations

Quarterly quality checks include the number of provider contacts and orders processed and verified.

Tele-Radiology Services The contractor will provide comprehensive tele-radiology services for the service unit/facilities in Montana and Wyoming within the Billings Area Indian Health Service. Contractor will contact the facility when the images cannot be interpreted and require additional imaging.

Contractor will document the interpretation and results in the Indian Health Service Electronic Health Record. Contractor will contact the facility with any urgent abnormal interpretation and/or results within 30 minutes of receipt of image(s) verbally and written (fax or notification via EHR to provider).

The contractor at a minimum will conduct quarterly training sessions with facility providers and imaging staff to improve and/or enhance imaging studies, etc. Contract will assess the proficiency of the imaging staff and provide recommendations to management to increase skill set of technicians.

Estimated volume of electronic medium by facility location:

Site Assessment The contractor will conduct a site assessment at each location that telemedicine services are requested. The assessment will include and identify the telemedicine needs, assess equipment and connectivity, staffing plan of needed personnel that would augment existing staff to support the telehealth specialty clinics, and formulate plans for implementation and education. One assessment would cover all potential telehealth specialty services including behavioral health assessments and hospitalist services. The completed assessment will identify at a minimum six (6) locations within each facility where telehealth specialty clinics will be provided including behavioral health assessments.

Site Implementation and Education Contractor will conduct and provider weekly implementation calls, manage change management efforts, champion development, conduct on-site go-live training, provide web-based education for staff that includes CME and CNE credits, and produce and deploy new provider onboarding education materials. The Contractor shall provide the necessary personal resources, equipment and infrastructure to manage, perform, and administer the contract throughout the performance period. The Contractor will be responsible for coordinating the logistics of all training to include but not limited to securing a site (with priority given to Federal facilities) for the trainings, payment of non-federal sites, and on-site and web-based registration services.

Physician Engagement and Retention The contractor will participate and be available throughout the contract period either on-sight and video presence at medical staff meetings. Physician to physician interaction is crucial for change management of telehealth specialty services. Efforts to educate providers on how telehealth specialty service can help support them from isolation, improve workflow, and how it can allow them a better work life balance; which will support provider retention.

Indian Health Service Electronic Health Record The contractor shall use the IHS Electronic Health Record (EHR) system to maintain accurate and up-to-date information on clinical care provided to patients. EHR systems are located at each IHS facility and remote access to each EHR system will be enabled through the IHS VPN system. The telehealth specialty services is to be provided via the agency's existing video and network infrastructure.

Upon contract award, the contractor shall ensure an adequate level of staffing is organized to meet the requirements and all contractor staff's credentials (e.g. security clearance, computer security training, and degrees and/or certifications, etc.) are current.

Credentialing and Privileges Upon contract award, the contractor shall ensure all clinical contractor staff meet requirements for Credentialed and Privileged in accordance with HHS Regulation and IHS policy. Credentialing and Privileging shall include, but is not limited to verification of U.S. licensure, board certification, periodic quality assurance review, and provider database queries, including the National Practitioner Data Bank. Clinical staff shall be fully credentialed and privileged at each site they practice in. All credentials shall be issued by accredited institutions in the United States and subject to Prime Source Verification. The contractor will make available their credentialing policy and procedures for review by IHS after which time IHS may decide to offer or decline privileging by proxy.

Reporting and Deliverables

Training The Contractor shall provide adequate level of training to the IHS staff to successfully support the telehealth services at the originating site. Contractor will schedule regular, ongoing training regarding the use and support of the telehealth equipment. Contractor will develop and/or provide enduring training materials in the form of recorded video or online learning modules in appropriate formats consistent with current technology and accessibility standards. Contractor will guide and assist with the development of IHS-approved standardized protocols for initiation of specialty consultation telehealth specialty services, to include indications and method(s) for initiation. Training plans and material will be provided at the request of IHS and are subject to review and approval by IHS no less than annually.

Performance and Best Practices The Contractor shall support and maintain telehealth specialty systems for IHS (not inclusive of the IHS network) in Billings Area.

Contracted staff will document all patient encounters in the IHS EHR.

Contracted staff will document, schedule, and maintain appointments utilizing the IHS Practice Management Application Suite, Scheduling Module.

Accurate Common Procedural Terminology (CPT) coding shall be documented for all patient encounters. Contractor will perform quarterly CPT audits for coding compliance.

Contracted staff will provide telehealth specialty clinics at the appointed time agreed upon by the site, during regular business hours, and meeting access to care standards for the visit type.

Documentation will be completed within 48 hours of patient contact.

If Specialty Consultant employs mid-level providers, the Specialty Consultant must be directly involved in every medical encounter.

The Contractor shall provide helpdesk support for the telehealth equipment, associated software, and other system issues. Contractor staff will respond within 15 minutes of being contacted by the originating site. Timeliness performance will be monitored as evidenced by no more than two substantiated complaints from the originating site in any three month period. Contractor will ensure that all telehealth equipment and any axillary appliances are in working order. Contractor will keep telehealth equipment up to date, including software security updates, functional updates, and updates that allow for additional clinical services upon request by the originating site.

The Contractor shall ensure an adequate level of staffing to meet the requirements and that all contractor staff's credentials (e.g., security clearance, computer security training, and degrees and/or certifications, etc.) are current and approved within either I HS or nationally recognized accreditation standards.

Contractor staff shall meet all federal, HHS and IHS rules, regulations, and policies regarding security, protected information, etc. There shall be no lapse involving contract staff security credentials or training. Services shall be adequately staffed with required security clearance status at all time. Immediate action shall be taken to remove unsuitable/ineligible staff from services and replacement of the staff shall be made within 24 hours with appropriately cleared staff. All required documentation required for security clearance process shall be submitted at least 30 days prior to the subject staff's performance start date.

The Contractor shall ensure all contractor staff communicate and coordinate effectively and efficiently with the originating site staff.

Security and Safety Contractor staff will be required to follow the procedures for obtaining a full Federal background investigation and preliminary clearance. No 3rd party investigation is allowed. In order to obtain a Personal Identity Verification (PIV) card, contractor staff shall complete and pass a Federal background investigation conducted by the Office of Personnel Management. IHS will process the investigations through the Office of Personnel Management on all contractor staff.

Processing of PIV cards shall be completed by the Billings Area HSPD-12/Suitability Office in conjunction with the physical locations throughout IHS and HHS that have PIV card stations. The contractors will be required to be physically present at one of the HSDP-12 enrollment and issuance workstations to obtain a PIV card. Biometric identification is required.

Each contractor shall complete each of the requirements below and receive pre employment clearance from IHS prior to performing services under this contract:

· Fingerprints must be captured electronically at a HHS enrollment workstation or via hard-copy card then sent to the Billings Area (BA) for digital processing;

· The OF-306, Declaration for Federal Employment, shall be completed;

· The Addendum to the OF-306, shall be completed;

· eQIP Information request must be turned into the HSPD-12/Suitability Office

· The eQIP questionnaire must be fully and accurately submitted; and

· The contractor must be enrolled for a PIV card at a HHS HSPD-12 enrollment workstation. Upon receipt of the card, the contractor must activate it at a HHS HSPD-12 card issuance workstation.

The Contractor shall ensure that the employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a contractor staff is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract.

The Government may investigate personnel at no cost to the Contractor. However, multiple investigations for the same position due to contractor personnel's employment change, termination or consequent re-investigations within one (1) year period, will lead to the reduction in the contract price of no more than the cost of the additional investigation.

Deliverables The contractor shall follow the reporting plan submitted as part of the proposal and keep the Government fully informed of status throughout the contract period. Throughout the contract periods, it is essential that attention be given to minimize interruptions or delays to work in progress that would impact the mission. All reports generated under the scope of the contract shall be Section 508 compliant.

The Contractor shall provide bi-annual status reports to the COR to include, but not limited to, the following:

Telehealth Specialty Clinics

· Number of patients seen

· By Clinic

· By Site

· Number of patients referred back to the referral source for continued care

· Number of patients requiring continued referral care via telehealth

· Number of patients requiring additional unique referrals to other specialist

· Any requiring additional unique referrals to other specialists

· Any official complaints

· Any adverse outcomes

The Contractor shall provide to the COR, annual performance reports that include but are not limited to project plan status and accomplishments, fiscal accountability, evaluation data, sub-Contractor performance reports (if applicable) and a Contractor self-evaluation report. The Contractor shall provide a written outline of the annual report to the COR for approval according to the deliverable schedule. The annual reports shall be delivered by e-mail and postal service according to the deliverable schedule before the end of the contract period. The annual report shall be discussed at the kick-off meeting.

Disposition of any national training and marketing materials will be determined in the kick-off meeting. Storage should be available as soon as national materials are generated. A disposition schedule will be discussed with the COR during the kick-off meeting.

The Contractor shall provide weekly updates and correspondence as determined necessary by the COR or BA CMO. The weekly conference call schedule may be adjusted as determined by the COR. The contractor shall provide deliverables as described in subsequent task orders. Deliverables shall be specified by the Government.

Indian Health Service System Environment

The table below provides information on Indian Health Service IT System Environment, within which telehealth specialty service shall be provided:

· Quality of Services is provisioned on the network to prioritize voice and video traffic.

· Access circuits onto the MPLS network range in capacity from multi T1s to DS3s and Ethernet circuits.

· Circuit bandwidth for the Billings Area sites accessing the MPLS network are listed below:

· Blackfeet – DS3

· Fort Peck – DS3

· Crow – DS3

· Northern Cheyenne – DS3

· Wind River – Four T1

· Supports ISDN through 4()PRI circuits (additional circuits can be added, if needed.

· Supports IP connections through the IHS Wide Area Network.

· Video Border Proxy hosted in the Albuquerque data center DMZ with an Internet facing interface.

· Video Gateway hosted in the Albuquerque data center DMZ with an Internet facing interface.

· Compatibility video end points are available.

· Two factor authentication.

· Windows based client access.

· See URL below for additional information.

· https://www.ihs.gov/citrix/

· The VA v5.0 HL7 Specifications document is available online: (https://www.va.gov/vdl/documents/Clinical/Radiology_Nuclear_Med/ra5_0hl7is.pdf)

· Several subscriber systems are already interfaced to the VA Rad/Nuc Med, including PowerScribe, TalkStation, and RadWhere.

· Future COTS interfaces to IHS via the VA Rad/Nuc Med must follow these specifications to comply with the existing interface design.

HHS Office of the Chief Information Officer (OCIO)

Deliverables mandated by HHS Office of the Chief Information Officer (OCIO) as follows:

Acceptance provided by the Information Systems Security Officer (ISSO).

Acceptance provided by the Information Systems Security Officer (ISSO).

Authentication Form Develop and update the E-Authentication Form using the provided IHS template.

Acceptance provided by the Information Systems Security Officer (ISSO).

Cloud Services Definition and Requirement Cloud computing is a model, defined by the National Institute of Standards and Technology (NIST)1, for enabling convenient, on-demand network access to a shared pool of configurable computing resources that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model promotes availability and is composed of five essential characteristics, three service models, and four deployment models, which are listed below.

An entity is a Cloud Service Provider (CSP) if the offered service possesses four or more of the NIST-specified essential characteristics. At their discretion, the IHS Chief Information Security Officer (CISO) or designee may declare any service offering that satisfies at least one NIST essential characteristics to be a cloud service and thus subject to the requirements below.

Examples of cloud services may include:

The Federal Risk and Authorization Management Program (FedRAMP) is a government wide program that provides a standardized approach to security assessment, authorization, and continuous monitoring for cloud products and services. Fed RAMP was by the Office of Management and Budget (OMB) on December 8, 2011 via official memorandum2 from the Federal Chief Information Officer (CIO) to all agency CIOs requiring the use of Fed RAM P when conducting risk assessments, security authorizations, and granting an Authorization to Operate (ATO) for the use of cloud services.

Eligibility for use of Cloud-based services: